Awatef Mohamed Ali with her son and daughter, Shahd, at a meeting in Assiut, Egypt this week. Photograph: Christina Rizk/Christina Rizk /UNFPA

Awataf Mohamed Ali’s son lies fast asleep on her lap, but her 10-year-old daughter, Shahd, is very much awake. In fact, she looks horrified. Ali has just calmly explained that in just 18 months’ time, if she can find a doctor willing to help, Shahd will probably be subjected to female genital mutilation.

FGM has been illegal in Egypt since 2008. But Ali claims that adherence to the law will result in her daughter “being ill-mannered and doing bad things, and being badly behaved”. Sitting to her left, Shahd says nothing. In this remote village in southern Egypt, girls’ bodies are not theirs to control.

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It is a similar story across much of the country: in 2008, Unicef estimated that 91% of married Egyptian women aged between 15 and 49 had been mutilated – 72% of them by doctors. In fact, the rate is so high in the country that “if we were able to eradicate FGM in Egypt, we could get rid of one-fourth of the cases worldwide”, says Jaime Nadal, the UN Population Fund’s (UNFPA) representative in Cairo.

Cases such as Shahd’s illustrate the uphill battle campaigners face to eradicate a practice that in poorer communities is still seen by many as a must. Ali has attended workshops run jointly by local NGOs, the health ministry and UNFPA – workshops that promote the religious, medical and humanitarian arguments against FGM. But while she admits she finds some of the arguments convincing, Ali says she cannot contend with the social pressure to conform, not least from her own family.

“My husband strongly feels that she should be circumcised,” she says. “It’s an inherited process, something that’s been going on for a very long time, and basically they want to continue it.”

There is no set age at which FGM occurs. Some are mutilated as toddlers, others as they reach puberty. But most operations take place in the summer and the process is often the same: relatives hold down the girl’s limbs to allow a midwife or doctor to cut her with a blade. A doctor may use anaesthetic, but a midwife often will not.

For the family, the mutilation is sometimes cause for celebration, with the daughter’s hands painted with henna. But for the daughter herself, FGM usually brings about severe physical and psychological trauma: humiliation, bleeding for several days, and, at worst, death.

Mansoura Mohamed, 33, remembers being mutilated before dawn, the first of three cousins to be cut that day. “There was a lot of blood, they had to get a lot of towels,” says Mohamed, who recalls the midwife as “an old lady, dressed in black. She was very violent, sometimes hitting me. Four people had to hold me down.”

Interviewed beside her husband and daughter at their home in another of southern Egypt’s poorest areas, Mohamed has come to terms with the experience. But it has taken her years.

“I used to have a lot of nightmares in which the lady who made the circumcision appeared in black,” she says. “I was psychologically traumatised because of it. On our marriage day, it brought back memories.”

FGM has reached such epidemic proportions because its proponents believe it stops women from becoming adulterous in later life. Some Muslim families also wrongly believe it is a religious requirement, and Christians practise it for cultural reasons. Doctors also exacerbate the problem, as some see FGM as a useful source of extra income. And since the dangers of FGM were only recently introduced to the curriculum at Egyptian medical schools, many also still believe it is a necessary procedure.

“It gives the girl more dignity to remove it,” one doctor in northern Egypt, Ahmed Almashady, told the Guardian last year. “If your nails are dirty, don’t you cut them?”

Children holding up anti-FGM pictures they drew at a school in Assiut, Egypt, on 1 February. Photograph: Christina Rizk/UNFPA

Iman Abdallah, a recent medical graduate, was educated about the medical risks of FGM by a UNFPA programme, but wasn’t taught about it at university. “There was no training, but out of personal interest I used to ask senior doctors in the university,” she remembers. “But not all of them gave clear replies. Some of them said it’s not mandatory, some of them said it’s not that big a thing, implying that it’s fine.”

But in pockets of Egypt, campaigners reckon the tide is turning, ever so slightly. In a crowded classroom near Assiut in southern Egypt, 60 schoolchildren – many of whom have themselves been mutilated – chant songs about the dangers of FGM. One of around 150 communities to be targeted by the government’s National Population Council (NPC), girls here say they are now convinced their younger sisters shouldn’t be mutilated, and speak with unusual candour about their own experiences.

After a class on the dangers of FGM, Nora Ahmed, 14, says she persuaded her parents not to inflict on her younger sisters the practice they recently put her through. “Based on my experiences with FGM, I discussed with them how it was a very bad practice,” she says, speaking frankly in front of her classmates. “And they agreed.”

For the NPC, Nora is an example of how there has been an increased willingness to debate the merits of FGM in the areas where they have established programmes. They also see signs that couples are more prepared to acknowledge how FGM leads to problems in their sex life.

“There is definitely a shift on the ground in terms of the openness of people,” says Mona Amin, who coordinates the NPC’s FGM campaign. “Young girls don’t feel embarrassed to talk about the problems of the practice in front of their parents. Previously even women who didn’t circumcise their daughters didn’t want to say. It’s a very important shift in attitude.”

Former Egyptian president Mohamed Morsi refused to condemn FGM during his time in power. Photograph: Maya Alleruzzo/AP

The change has also been reported in the religious sphere. Mohamed Suleiman, a leading imam in Awataf Mohamed Ali’s province, claims the number of imams who support FGM in his network has fallen from an overwhelming majority to a significant minority in the space of just a decade.

According to Suleiman, this is because liberal-minded imams have become more vocal in their criticism of the practice. For years, FGM’s proponents used a vague saying attributed to the prophet Muhammad to justify their actions. But imams such as Suleiman and Mahmoud Abdel Samir, who wrote a PhD tackling this claim, say it is unlikely Muhammad advocated it.

“FGM has no reference in the Islamic religion,” says Samir, an influential government-appointed imam in a neighbouring province. “It refers back to pharaonic or African habits and doctors do it for their personal financial benefit.”

The medical profession is also undergoing gradual change. The health ministry and the UNFPA are retraining 1,000 doctors a year about the dangers of FGM. This is a small cohort, given that another 9,500 new clinicians will graduate this summer. But it has had at least one significant effect.

The landmark recent conviction of an Egyptian doctor for practising FGM was thanks in part to the testimony of a local health official who had been trained under the new scheme. “He was the hero of the case,” says Dr Vivian Fouad, a spokeswoman for the NPC’s FGM programme. “He said he saw an injury in the area of the clitoris. The conviction was because of this.”

The conviction was shockingly only the first since FGM was banned seven years ago. But while it was a long time coming, the case is also an important staging post. The local media coverage it sparked was unprecedented, while the strength of the prosecution’s case was also partly derived from the recent training that prosecutors have received about how to tackle FGM cases.

Mansoura Mohamed with her husband Ragab and daughter, Ghada, near their home in Assiut, Egypt. Ghada will not undergo FGM. Photograph: Christina Rizk/UNFPA

Their work has led some campaigners to hope that the results of a forthcoming survey will show that FGM prevalence has fallen since 2008. But UNFPA officials caution that the children of those most won over by counter-arguments to FGM may not have yet reached the relevant age range to be taken into account. And FGM’s opponents are still counting the cost of the Muslim Brotherhood’s brief moment at the helm of Egyptian politics between 2011 and 2013, when Islamist MPs proposed legalising FGM again, and the then-president, Mohamed Morsi, refused to condemn the practice.

“The problem in 2011-13 was that those [in favour of] the practice had the loudest voice in the community,” says Amin. “There was a strong attempt to empower the regressive voices that said, no, you need to circumcise your daughter.”

As a result, says her colleague Fouad, to end FGM “we need another generation. In a good political atmosphere.”

But if you know where to look, there are hints of a brighter future. After Mansoura Mohamed was so traumatised by her experience, she and her husband, Rageb, agreed not to mutilate their 14-year-old daughter, Ghada.

The pair were criticised for it, Rageb remembers. “They said the girls would become ill-mannered,” he says. “But what counts is their upbringing.” And 20-odd relatives, crammed into Rageb’s front room to hear him talk, nod in agreement.

Transport and accommodation costs incurred while reporting this article were paid by the UNFPA.